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A Good Alternative To Mandatory Health Insurance

When I wrote last week about how health care reform in it’s current version does not equal a government-run health care system, we got a really great comment from Jim Sugden. He wrote:

“Although a mandate is the easist method of enforcing enrollment compliance by the majority of the population, a stiff pre-ex clause that was well publicized and understood could also be used to drive participation. If individuals who had gone uncovered for 60 days or more were subjected to a pre-ex. waitng period of 1 month for every month the spent without coverage(perhaps with a 24 month maximum),insurers would have protection from those wishing to game the system. They would then be better able to extend guarentee issue without being selected against.”

I really like this idea, and think that it could serve as a compromise between the people who are completely opposed to a mandate requiring everyone to carry health insurance, and the people (like myself) who feel that there is no realistic way to offer guaranteed issue, affordable health insurance unless everyone is required to be in the pool of insureds.

The people who are opposed to the mandate are usually either in the camp of not wanting to contribute to insurance company profits, or not wanting the government to tell them what to do. And they make up a large percentage of the American public.

However, the idea of guaranteed issue health insurance is very popular, with most people supporting the idea that health insurance companies shouldn’t be allowed to decline applicants or exclude pre-existing conditions. Yet without some way of making sure that people don’t simply wait until they get ill to buy coverage, a guaranteed issue system would not be sustainable.

Jim’s idea seems like a good compromise. To be fair to all of the people who had not previously been able to buy health insurance because of pre-existing conditions or because they had no access to guaranteed issue policies, perhaps at the initial switch to guaranteed issue coverage, we could set up a three or six month window during which all applicants would be accepted without pre-existing condition limitations. But once that window closed, we could use a system like the one Jim described. That way, there wouldn’t be an incentive for people to remain uninsured and wait until they got sick to purchase health insurance. The choice to be uninsured would come with consequences, but it would still be a legal choice. This would allow people to make their own decisions, but would also protect health insurance companies and people who maintain continuous coverage.

Of course, there’s a bit of grey area involved with the pre-existing condition waiting periods that doesn’t happen with mandatory health insurance. If a person feels ill but doesn’t go to the doctor to get checked out prior to getting health insurance, there wouldn’t be any proof that the condition was indeed pre-existing. There would have to be some sort of leeway for discussion between insurance companies and doctors to try to determine how long a patient might reasonably have known about the condition. This would be somewhat subjective, and would be a problem that would have to be addressed before a strong pre-existing condition waiting period could take the place of mandatory health insurance. But overall, I think that the idea has a lot of promise.

Would you be more likely to support a mandate requiring everyone to carry health insurance, or a pre-existing condition waiting period like the one Jim proposed?